State of Florida PIP Summary Form Completion Instructions

1 State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 1 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc. These Instructions should be used as a guide during the Completion of the PIP Summary form . Each section provides detailed information on the documentation requirements for each activity. DEMOGRAPHIC INFORMATION Plan Name: <Plan Name> Project Leader Name: Title: Telephone Number: E-mail Address: Name of Project: <PIP Topic> Type of Project (for HSAG s internal tracking): Clinical Nonclinical Collaborative HEDIS Section to be completed by HSAG Year 1 Validation Initial Submission Year 2 Validation Initial Submission Year 3 Validation Initial Submission Baseline Assessment Remeasurement 1 Remeasurement 2 Remeasurement 3 Year 1 validated through Activity.

2 Year 2 validated through Activity . Year 3 validated through Activity . Type of Delivery System: Date of Project: to Number of Medicaid Enrollees Served by the Managed Care Plan: Number of Medicaid Enrollees in the Sample (if applicable): Number of Medicaid Enrollees in the Eligible Population: Submission Date: State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 2 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc. Activity I: Select the Study Topic. The study topic should be selected based on data that identify an opportunity for improvement. The goal of the project should be to improve processes and outcomes of health care.

3 The topic may be specified by the State . Study Topic: Clearly State the study topic. Specify if the topic was assigned by the State or is a statewide collaborative PIP topic. Explain how the study topic was selected, addressing the following required HSAG evaluation elements: 1. Was selected following collection and analysis of data. (Critical Element) Provide plan-specific data collection and analysis to support the selection of the study topic. If no plan-specific data were available, provide rationale for why it was not included. If the study topic was selected by the State , this must be specified in the PIP Summary form . 2. Has the potential to affect enrollee health, functional status, or satisfaction. The narrative should explain how the study topic has the potential to affect enrollee health, functional status, or satisfaction.

4 The link between the study topic and outcomes of care should be explained in Activity I. State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 3 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc. Activity II: Define the Study Question(s). Stating the question(s) helps maintain the focus of the PIP and sets the framework for data collection, analysis, and interpretation. Study Question: Enter written PIP study question(s) here. Ensure the study question(s) addresses the following HSAG evaluation element: 1. States the problem to be studied in simple terms. (Critical Element) The study question(s) should be stated in the recommended format, Does doing X result in Y? Define terms used in the study question(s) that may be unclear.

5 The study question(s) must be answerable through the proposed data collection methodology and study indicator(s) provided. State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 4 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc. Activity III: Define the Study Population. The study population should be clearly defined to represent the population to which the study question and indicators apply, without excluding enrollees with special health care needs. Study Population: Describe the population and methods for identifying the study population, addressing the following HSAG evaluation element: 1. Is accurately and completely defined and captures all enrollees to whom the study question(s) applies.

6 (Critical Element) Clearly define inclusion, exclusion, and diagnosis criteria, if applicable. Include a list of diagnosis codes or system codes used to identify enrollees, if applicable. Include the complete age range and any anchor dates used to identify age criteria, if applicable. Include actual HEDIS technical specifications used in the study to define the study population, if applicable (may provide as an attachment). Define continuous enrollment, new enrollment, and allowable gaps in enrollment, if applicable. Include any dates used to identify continuous enrollment criteria. Include how race/ethnicity will be identified, if applicable. Should not exclude enrollees with special health care needs. If these enrollees were excluded, the plan must provide the rationale. State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 5 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc.

7 Activity IV: Select the Study Indicator(s). A study indicator is a quantitative or qualitative characteristic or variable that reflects a discrete event or a status that is to be measured. The selected indicator(s) should track performance or improvement over time. The indicator(s) should be objective, clearly and unambiguously defined, and based on current clinical knowledge or health services research. Study indicator goals should be specific, measurable, attainable, relevant, and time-bound. Study Indicator(s): There is a minimum requirement of one study indicator. The plan may submit additional indicators based on the focus of the PIP. List any details or background information about the indicator(s) and how they were selected. Enter the study indicator(s) in the table for Activity IV, ensuring that, at a minimum the study indicator(s): 1.

8 Are well-defined, objective, and measure changes in health or functional status, enrollee satisfaction, or valid process alternatives. (Critical Element) Provide study indicator(s) that are objective and measurable. Complete descriptions of the numerators and denominators should be provided. Define terms used in the indicator(s). Include any codes used to define numerator events. Provide the description/rationale for each study indicator(s). Include all starting and ending dates for all measurement periods. The study indicator(s) should provide data to answer the reported study question(s). The study indicator(s) and study question(s) should align. Data should be available through administrative sources, medical records, surveys, or other readily available sources. If the study indicator(s) are nationally recognized measures, such as HEDIS measures, this should be explained in the PIP documentation.

9 The year of the specifications should also be included and updated annually, if appropriate. 2. Include the basis on which indicator(s) was adopted, if internally developed. If the study indicator(s) were internally developed, the rationale and explanation why each study indicator(s) was chosen for the PIP should be provided in the PIP Summary form . State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 6 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc. Activity IV: Select the Study Indicator(s). A study indicator is a quantitative or qualitative characteristic or variable that reflects a discrete event or a status that is to be measured. The selected indicator(s) should track performance or improvement over time.

10 The indicator(s) should be objective, clearly and unambiguously defined, and based on current clinical knowledge or health services research. Study indicator goals should be specific, measurable, attainable, relevant, and time-bound. Study Indicator 1: Enter title of study indicator Provide a narrative description and the rationale for selection of the study indicator. Describe the basis on which the indicator was adopted, if internally developed. Numerator: (no numeric value) Denominator: (no numeric value) Baseline Measurement Period (include date range) MM/DD/YYYY to MM/DD/YYYY Remeasurement 1 Period (include date range) MM/DD/YYYY to MM/DD/YYYY Remeasurement 1 Period Goal Remeasurement 2 Period (include date range) MM/DD/YYYY to MM/DD/YYYY Remeasurement 2 Period Goal State -Designated Goal (if applicable) or Benchmark Source of Benchmark State of Florida PIP Summary form Completion Instructions PIP Summary form Completion Instructions Draft Copy for Review Page 7 State of Florida PIP-Val_SummaryInstructions_D1_0217 2007 Health Services Advisory Group, Inc.